Johnson, Shantana D
Johnson, Shantana D is an sole proprietor health care provider with primary practice located at 1920 Verano Dr Ste 105 , Haines City FL 33844-8585. She recently has 10 registered licenses in different health care specialties including Agencies / Foster Care Agency, Agencies / In Home Supportive Care, Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, Respite Care Facility / Respite Care, Mental Illness, Child, Nursing Service Related Providers / Homemaker, Respite Care Facility / Respite Care, Respite Care Facility / Respite Care Camp, Respite Care Facility / Respite Care, Mental Retardation and/or Developmental Disabilities, Respite Care Facility / Respite Care, Physical Disabilities, Child, Agencies / Home Health. Agencies / Home Health is her primary health care specialty. Johnson, Shantana D can be contacted via phone (321) 217-2409.Contact Information
Primary practice address
1920 Verano Dr Ste 105
Haines City FL 33844-8585
Phone: (321) 217-2409
Fax: (855) 257-1340
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Agencies / Foster Care Agency | 253J00000X | ||
| Agencies / In Home Supportive Care | 253Z00000X | ||
| Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 320600000X | ||
| Respite Care Facility / Respite Care, Mental Illness, Child | 385HR2055X | ||
| Nursing Service Related Providers / Homemaker | 376J00000X | ||
| Respite Care Facility / Respite Care | 385H00000X | ||
| Respite Care Facility / Respite Care Camp | 385HR2050X | ||
| Respite Care Facility / Respite Care, Mental Retardation and/or Developmental Disabilities | 385HR2060X | ||
| Respite Care Facility / Respite Care, Physical Disabilities, Child | 385HR2065X | ||
| Agencies / Home Health | 251E00000X | 299995365 | Florida |
Profile Details
| NPI number | 1528734548 |
|---|---|
| LBN Legal business name | Johnson, Shantana D |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 19th, 2021 |
| Last updated | Jun 26th, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528734548 | NPPES |
| Florida | MEDICAID | 022449300 | |
| Florida | MEDICAID | 108545900 |
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